The problem with Type I diabetes is that your own immune system has identified the cells that produce insulin as foreign, and attacks them, killing them all off. You physically have no cells left, and there is no other way for your body to produce insulin, which it needs, except by injection.
‘You’ve got to be careful with that online stuff.’ I tried to let him down gently. ‘There’s a lot of conmen out—’ He cut me off.
‘But the testimonials are from real doctors.’
I’ve seen fake cures before. For practically every disease known to man, you can find a website offering a cure. I asked him if there was a cure why the rest of the world didn’t know about it.
‘Because of the money, those corporations … it even says it right here.’ He then showed me the line where it said:
Two new scientific breakthroughs the pharmaceutical companies and health gurus don’t want you to know about …
Roman sat with me as we researched the author of the website and then googled him. We came up with some scary results.
Real reviews from genuine people explained how it was a con, and one reviewer even said that he’d started his own website to counter the lies, but he’d been hit with a very scary letter from a top law firm, telling him to take it down, or prepare for war.
Roman’s hopes weren’t just dashed; they were ripped to pieces and stomped on. The boy with the needle phobia still had a lifetime of pinpricks in front of him.
The internet is the source of so much misdirection and false hope for those in genuine need – someone like Roman – that it becomes difficult to know who to trust. With so many fraudsters and conmen preying on those who require help and advice, the internet can be a daunting, and frustrating, place for medical practitioners.
The iliac crest?
Molly was a walking, talking, breathing symptom. In the three years I’d known her, she’d grown from a shy little girl to a demanding sixteen-year-old phony, and held the record for most visitations to the health centre; she was a hardened veteran.
Her favourite presentation was the migraine, and she even had a letter from a doctor at home diagnosing her with frequent migraines. But the doctor didn’t prescribe any special medicine, and her attacks often coincided with PE, skiing, and bad weather.
The next most common symptom was cramp.
‘How would you know, sir, you’ve never had one,’ she always protested when I told her that menstrual cramps are not an illness, but if she didn’t feel up to participating in an activity, she would still have to go there and sit and watch. When you say this to most kids, they end up joining in, but Molly wouldn’t. She would just sit there, content, her fingers flying across her iPhone.
‘She’s up to something,’ Michaela declared after giving Molly the all clear for the second time in three days. Molly’s presentations had become more frequent of late, and I began to wonder if this was part of a bigger plan. But we were worried; there’s nothing worse than assuming that just because someone is a regular faker, they’re always faking it, and we didn’t want to miss anything. So, we referred her to the doctor.
Dr Fritz described her as ‘a picture of health’, although he did some simple blood tests to give us something concrete. When they came back normal we referred Molly to Cathy, the counsellor, just in case we were missing something psychologically wrong with her.
Cathy didn’t hold back. She told Molly that the nurses were tired of her presenting symptoms that never followed any rule, headaches that last one hour, nausea that settled just in time for dinner, cramps that enabled her to pick and choose what activity she wanted. Molly handled the truth like most teenagers – denial, then tears, followed by a promise to improve.
With the school trips coming up, I had been worried that this latest presentation was a tactic to avoid them. As Molly was in the third form, she was set to go on the Outdoor Adventure trip, a physically gruelling hike. It’s a compulsory expedition, but there’s always some students that attempt to get out of it.
We didn’t see Molly for one whole week. For her, that’s unheard of, and with the school trip only three weeks away, I thought that maybe I’d misjudged her.
But she came back with a vengeance.
She hobbled into my office, bent in half, her arms crossed over her abdomen. ‘It’s so bad,’ she said, slumping into the chair. If it were anyone else, I would have shown some reaction, and when I didn’t respond, she glanced up and added, ‘I’m not pretending; it’s real this time.’
Teenage logic dictates that admitting you were faking it previously somehow gives more credence to your current situation. I told her to get up on the examination bench.
‘Where’s it sore?’ I began and instead of touching the middle of her stomach like she normally did, her hand brushed the lower right-hand side of her abdomen.
‘You’ve got a sore hip?’ I asked, deliberately misinterpreting her, but she shook her head.
‘My stomach, the iliac crest …’ she dropped the term in casually. ‘You’re the doctor, you know better than me.’ She was close. The words she was looking for were ‘right iliac fossa’ or the right lower side of the stomach. Pain here automatically sets off alarm bells of suspected appendicitis. Molly was inching towards a self-diagnosis.
If it was her appendix, she needed to go to the hospital straight away, but her choice of words was suspicious. I began my investigation.
She had no fever (an almost-must with appendicitis), but she said she’d had one during the night – plausible.
She had no pain anywhere else; a typical presentation begins with pain around the middle of the stomach, which gradually moves to the right.
Her pulse and blood pressure were fine.
But, of course, I had to be sure.
‘We better go to the doctor,’ I said, and she was fine with this, but when I added that we might even have to go to the hospital she had a change of heart.
‘It’s not that bad. I just need some painkillers, that’s all.’ There was no getting out of this, and I told her that based on her symptoms, we had to see a doctor right away.
‘But I don’t want one of those camera things,’ she said, and I asked her what she meant. ‘You know the camera, I saw it online, a …’ she paused, ‘the gastric thing … gastroscopy, that’s it. I’m not having that, it looks torture.’
It would be torture if they tried to find her appendix that way. The camera would have to travel through a few feet of intestine. It’s not an option; an ultrasound or even CT scan is sometimes used, but often, when the symptoms are obvious, they go straight in and operate.
There are other possible causes for these symptoms. She could be constipated. She could have a UTI (urinary tract infection). But I’m not a doctor, just a nurse.
Dr Fritz ran a number of blood tests, all of which showed no sign of infection or inflammation: an x-ray showed she wasn’t constipated, her urine was clear, and she wasn’t pregnant. Dr Fritz wasn’t convinced it was her appendix, but Molly was unrelenting in her pain and so I took her to hospital.
I last saw Molly as she was wheeled off to theatre. The surgeons weren’t convinced, but could find no other explanation. The appendix was normal, but they took it out anyway.
Molly was back at school two days later, lapping up the attention from her friends and teachers. She was tender around the incision sites, but this faded when she found out she would be excused from her trip.
Was Molly faking it? Did she search symptoms online? Well, she virtually admitted as much, but did she realise how far it would go? Sometimes once you commit to a path, there’s no turning back, and she may have had an invasive operation she never needed.
Reply all
When it comes to using a computer, unfortunately, I’m not as competent as Molly or most of the other students. However, most everything I do these days is electronic, from writing my notes, sending out appointment schedules, contacting parents or – as Roman and Molly did – researching symptoms and cures.
Doing everything online is great when everything goes right, but slip-ups do happen. And the problem with slipping up online is that everyone usually finds out.
I’d recently found a good article giving advice on how to stop smoking and reposted it to the faculty and student body. I often send links to the rest of the school when I find something that I think could be productive. At the very least these articles spark discussion; but this time something different happened.
Shortly after I’d sent the link, I received a new email alert.
Dear sir, I don’t mean to be rude, but you’re wasting your time. If we want to stop smoking, we will, but there is nothing you can say to make us stop.
The email was signed ‘Eduard’, and the little git hadn’t just sent it to me, but to the whole school.
‘Who the hell is Eduard?’ I just about managed to refrain from instantly replying – such rash responses only tend to exacerbate the situation. Instead, exasperated, I went to Michaela for advice. She had no idea either. Eduard wasn’t a regular; he was one of the few kids we did not know.
‘Just ignore it,’ she suggested, but I couldn’t.
‘I’m going to do the right thing,’ I said, and Michaela shook her head in resignation. ‘Oh geez, what you going to do?’
I wanted to be the better person, and to try and help him. He probably expected me to be angry. Instead I replied:
Sorry to hear you feel that way, Eduard, although I’m not so sure everyone thinks the same as you. Perhaps you’d like to come to my office and we can talk about it directly, as emails don’t always say what we mean. Perhaps I am wrong, but you sound a bit upset.
I replied to him only, and cut out the rest of school. I got a reply ten minutes later:
I’m sorry sir, but I’m not wasting my time. We will stop when we want to, and not because you think you know what’s good for us. You don’t know us. You don’t know about smoking.
He had posted it all to the whole school, and I was hit with two further emails from students supporting his stance.
There were three emails from teachers on my side, the last of which, from Ms Strawbridge, read: ‘What a prick’.
‘If he wants war, he’s going to get one.’ I was pacing about Michaela’s office, trying to let off steam. ‘Who the hell does he think he is? What good has he done anyone, eh?’ Michaela reminded me that I should have let it go. ‘Some battles just aren’t worth it,’ she said. ‘You’re never going to win this one.’
I did calm down, and I did give up, but not before sending an email to Mr Driscoll, containing the full chain of emails, and the comment, ‘I’m not sure he’s broken any rules, but he seems pretty angry to me, and his tone is disrespectful. Do you think it’s worth having a friendly chat with him?’
‘She called him a prick.’ The reply came … but not from Mr Driscoll
Ah.
It appeared I hadn’t sent the email solely to Mr Driscoll, but to the whole school.
‘Ms Strawbridge thinks he’s a prick …’ dozens of emails were now joining in.
‘That doesn’t sound very professional to me.’
‘I think he should sue.’
‘Instant dismissal, that’s what I say.’
‘What’s a prick?’
‘The Oxford English dictionary defines it as …’ This reply listed a dozen definitions, the last of which said ‘Slang, derogatory an obnoxious or despicable man’.
‘She can’t say that!’
Well, there goes my good deed for the year, and possibly Ms Strawbridge’s job. I’d really tried to help, be responsible, be above anger, and be forgiving.
I turned my phone off that night and hid from Ms Strawbridge.
I’ve stopped posting articles to the whole school. It’s just too risky. As for Eduard, well, he had a friendly chat with Mr Driscoll, but suffered no punishment, while Ms Strawbridge was given a gentle reminder about ‘being professional’ but received no disciplinary action. Meanwhile, the IT department had a horrendous 24 hours trying to remove every trace. Sadly, I’m sure there’s a copy somewhere in cyberspace, waiting to bite me, and Ms Strawbridge, in the butt when we least expect it.
Freddy
I don’t care what anyone else says, I can’t live a lie anymore. I’m coming out the closet. There, I said it. I’m gay.
I hadn’t seen this coming for Freddy, but the manner in which he made his announcement was just like him: loud and shocking.
Facebook is a great medium to share your feelings and secrets, no matter how intimate or mundane. I don’t think there was another way he could have been more public. Even a YouTube clip of his ‘coming-out’ would not have been as effective as he had thousands of Facebook friends, each of whom would have told the rest of their friends they ‘liked’ Freddy’s post.
Freddy was no longer one of our students, he was a young man who had recently dropped out of university to pursue a career in acting. I had known him for four years. I wondered how I hadn’t seen the signs.
When I’d first met Freddy, he was an annoying little boy.
‘He’s got ADHD,’ his mother had explained when I met them on open day, ‘but I don’t believe in using drugs.’ Freddy hadn’t made eye contact with me once, but he wasn’t sullen and staring at the ground either. Instead, he was playing with my stethoscope, twiddling with the stationery on my desk, while his ears were plugged into an iPod, his head bopping along to the music.
Should I make him remove them? I wondered. Or should I tell mum to tell her son to remove them? She didn’t seem to notice his behaviour, so I asked him to take the headphones off. He didn’t say a word, didn’t make contact in any noticeable way, his head kept banging along to its own beat. Maybe this was part of his ADHD, but I felt he was trying hard to ignore me.
After my first year of getting to know Freddy, I came to the conclusion that he did not have ADHD because he could concentrate fine when he wanted to and could sit still if needed; he seemed to choose which impulse he was going to act out on. ‘I don’t have ADHD,’ he even told me. ‘I’m just passing time.’
Over the years, I got to see how good Freddy was at heart, but also to pick up the pieces when he showed us just how wild and immature he could be, getting drunk while DJ-ing the school prom, for example, or renting an apartment in the village in his name, which the students used as a sex and drinking pad.
Now that he was an adult coming out the closet, I naturally wondered if his rebellious behaviour was a result of conflicting emotions. I sent a reply via Facebook: ‘Good on ya, mate. You have to be true to yourself, it’s the only way to be happy. PS – always knew you were different.’
I got an instant reply:
‘What you mean you knew I was “different”? I didn’t write that message. Someone broke into my account and posted it. I’m not gay. I’ve never been even remotely gay and never will be. I’ve been fraped.’
Facebook rape, also known as ‘frape’ (a horrible term if there ever was one), involves someone hijacking your Facebook account and posting messages and statuses in your name.
Well, this was embarrassing, although I wasn’t worried because Freddy and I had always got along and always been able to take or give a joke.
Thankfully, Freddy saw the funny side of my mistake in the end. He has kept in contact, and since dropping out of university has begun getting small acting jobs and starred in some commercials. To him, school was just a way of passing time while his real passion was acting. ‘When I’m famous I’m going to tell everyone how you always knew I was “different”,’ he likes to remind me.
That was my first experience of ‘frape’ and I’ve since been a victim myself.
Fortunately, it wasn’t anything as dramatic as announcing I was gay, but I wasn’t too keen to be seen to be endorsing ‘legal highs’ either. I often wonder who was responsible. Secretly, I think it was Freddy having sweet revenge from afar … but it was probably just the wife having a laugh.
Electric friends
When I was young I spent a few years travelling, working my way around the world. This was before Facebook, iPhones, Twitter and the rest of those social media websites, were created. In fact, I think even the internet was pretty new at this time. The best thing about travelling is that you meet so many wonderful people, people that you often share special times with, that your diary becomes full of scribbled, often exotic sounding, names and addresses. It was not electronic, or kept on a smartphone. I had to lug it around in my bag.
I no longer have that address book. I lost it – but it doesn’t matter because it no longer had any value. I remember going through it a few years after my time travelling having absolutely no idea who three-quarters of the people were! The quarter that I did remember were people that I still considered friends and who, if I were to contact today, might actually have some interest in catching up.
These days, I’ve got over 500 Facebook ‘friends’, but it’s the same thing; it’s full of people I barely remember and know I will never see again. But 500 is a small number compared to the amount of friends most of my students have.
‘I have 2132 friends.’ Michelle was in my office because she wanted to be my Facebook friend. ‘Why won’t you accept my invitation?’ I explained that I don’t ‘friend’ current students. ‘But why? You’ve known me for five years. You know me better than anyone, except Mum and Dad.’ I asked her if she was FB friends with her parents. ‘But you’re not my dad, it’s different. You’re a …’ She paused as she tried to find a classification for me. ‘You’re a, um, well a friend sort of, but not a friend like my normal friends my age.’
‘Thanks … I think.’
Not all students considered me their friend; and there were plenty that probably considered me an enemy combatant, but when you spend five years with someone, watching them transform from pimply adolescent to mature young adult, helping them through the typical teenage hurdles, I can see how it can be confusing.
Confessions of a School Nurse Page 15